Testosterone replacement therapy - is it needed? Hormone replacement therapy for men: testosterone preparations Hormone therapy for men after 50 years
After 40 years of age, men experience hormonal changes that significantly suppress physical and sexual activity, mental abilities. Outwardly, this is manifested by obesity in the abdominal region, a decrease in muscle mass, a deterioration in general well-being, and sometimes depressive syndrome develops. For treatment, HRT for men is prescribed - testosterone replacement therapy. Preparations based on hormonal components help restore the level of testosterone in the blood, thus avoiding harmful effects. Consider what hormone therapy is, to whom is it recommended, and what are its contraindications?
What is Testosterone Therapy?
Hormonal disorders in the body lead to serious complications from all organs and systems, without exception. Therefore, hormone replacement therapy after 40 years for men is often the only treatment that can significantly improve the quality of life and avoid health problems.
Hormonal drugs are prescribed not only to men over 40, but also at a young age, since testosterone deficiency is not always caused by age-related changes in the body. The cause may be trauma to the spermatic cord, cancer, genetic pathologies, etc.
It is worth knowing: symptoms of testosterone deficiency include a decrease / lack of libido, chronic fatigue, depression, aggressiveness and irritability for no reason, erectile dysfunction, obesity against the background of a previous diet, an increase in mammary glands. If there are 3 or more signs, it is recommended to consult a doctor and take a blood test for the level of androgens in the blood.
Testosterone replacement therapy was carried out at the dawn of the last century. But its beneficial effects were only confirmed 40 years ago. Moreover, there is still no unequivocal opinion whether such a method of treatment is needed or not, which is due to the most severe side effects, sometimes of an irreversible nature.
Previously, hormone therapy was carried out using tablets that included artificial testosterone. After taking them, the metabolism took place in the man's liver, where most of the active substance was destroyed. As a result, the liver "suffered" from the negative effects of carcinogenic and toxic components. This led to a violation of the functionality of the internal organ, which became the reason for the prohibition of such treatment in many countries of the world.
However, when similar drugs appeared that were not characterized by such adverse reactions, the ban was lifted. Often, these medicines are used by men who are professionally involved in sports, although this is prohibited.
HRT with testosterone has strict medical indications:
- Natural andropause, due to which there is a pronounced deficiency of testosterone in the blood;
- Pathological conditions, regardless of the age group of a man, are accompanied by hormonal disorders. For example, diseases of the pituitary gland, gynecomastia, cryptorchidism, obesity, which cannot be treated with traditional methods.
Hormone therapy for men is carried out only on the basis of laboratory test results. When prescribing drugs with synthetic testosterone, all risks are necessarily assessed.
Methods for administering androgens
In modern medical practice, androgens are administered in various ways. Each method is characterized by its own advantages and disadvantages, therefore, the choice is always made on an individual basis, taking into account the condition of the man, concomitant diseases, clinical manifestations, and other factors.
Oral
Oral hormone replacement therapy for men involves the use of tablets / capsules by mouth. They contain the active ingredient in the required dosage. Pills are the very first form of hormonal drugs.
The advantages of the method:
- Ease of use.
- Possibility of urgent withdrawal of the drug.
- Independent use without visiting the clinic.
- Relatively low cost.
Important: tablets / capsules are effective only for mild androgen deficiency in the male body.
The tablet / capsule form is sold by prescription only. It is not recommended to buy online and in questionable stores, since this form of the drug is easiest to counterfeit. The replacement process is carried out with the help of such drugs:
- Andriol. The dosage is 150-200 mg per day;
- Streant is taken at 30 mg three times a day;
- Proviron. The dose will vary depending on the level of androgens in the blood. Prescribe from 30 to 80 mg per day.
The tablets must be taken in the dosage prescribed by a medical professional. During treatment, the concentration of hormones in the blood should be constantly monitored.
Injectable
According to many doctors, it is necessary to "harmonize" by the injection method, since this is the only way testosterone enters the body smoothly and naturally. In most clinical pictures, cypionate and enanthate are used for testosterone therapy. Literally 100 mg of the drug provides a weekly supply of androgens for the male body. The dose is always individual - some men need less, others much more.
The weekly dose is divided into two applications, administered at regular intervals, which ensures a stable concentration of hormonal substances in the body. The following drugs are used:
- Delasteril. The dose ranges from 200 to 400 mg.
- Nebido. Enter once every three months.
- Sustanol. The introduction of 250 mg is carried out every 1-2 weeks.
Fact: Among all hormonal medicines, it is Nebido that is characterized by the most prolonged effect - one injection every 90 days and the minimum list of side effects.
The advantages of injection include the ability to create a high concentration of hormones in the blood; a wide range of new generation drugs.
Transdermal
There are other ways to "replace" the hormone in men. For this, plasters, creams and gels are used. Local agents provide a gradual intake of the active component into the male body, which reduces the risk of side effects. Nevertheless, according to medical experts, the therapeutic efficiency of this method is the lowest.
HRT in men by the transdermal method is carried out using drugs:
- Androderm or Testoderm - plasters. They are used every day at a maximum dose of 7.5 mg of the hormonal substance;
- Andromen is a hormonal cream. The daily dosage is 15 mg;
- Andractim is a drug in the form of a gel, the dose is always determined individually.
During hormone therapy with gels and creams, do not swim after applying medications. It is strictly forbidden for women and children to touch the treated area of the skin, as this poses a health hazard. A significant disadvantage is that it must be applied several times a day, which significantly reduces the quality of life and the usual way.
Subcutaneous
Subcutaneous hormone therapy involves the use of an implant. The method is quite effective, however, testosterone implants are not registered in Russia, which does not allow many representatives of the stronger sex to use this option.
For your information, the main advantage of the method is the uniform release of testosterone throughout the entire period of the implant's operation - 6 months.
The disadvantage of the method is surgical intervention, since the operation appears to be the only way to install the implant. Therefore, the risk of complications after surgery is added to the side effects of hormonal treatment.
Contraindications for substitution therapy
Hormone replacement treatment is a serious step, therefore, before prescribing drugs, you need to make sure that there are no medical contraindications. In addition, the doctor must tell the man about the likely side effects. Contraindications are relative - the use of hormonal drugs is allowed, but with caution and absolute - such treatment is strictly prohibited.
Testosterone replacement therapy is not performed if a man is diagnosed with breast cancer (this is rare). The use of androgens can provoke an increase in the concentration of estrogens, which leads to the progression of the oncological process.
Important: testosterone replacement therapy is prohibited against the background of cancer of the glandular organ in men. Oncology must be excluded before treatment. For this, a rectal examination of the organ is carried out, the level of PSA - prostate specific antigen is determined.
The use of hormones is carried out with caution in the following pathological conditions and diseases:
- Sleep apnea.
- Gynecomastia.
- Retention of fluid in the body.
- Puffiness.
- Polycythemia.
- Hyperplasia of the prostate gland.
In the presence of relative contraindications, constant monitoring by a medical specialist is required. The introduction of hormonal drugs can lead to serious complications - suppression of the production of own testosterone, inhibition of spermatogenesis, alopecia, atrophic changes in the testicles, etc.
The final choice of the method of hormone replacement treatment depends on the general condition of the patient, concomitant diseases and individual tolerance of certain medications. Testosterone in any form should be prescribed exclusively by a doctor, independent use is fraught with serious consequences.
Prevention of testosterone decline is the correct lifestyle (quitting smoking, alcohol, drugs), consuming organic products, controlling your own weight, and timely treatment of any diseases.
26 February 2010Until recently, diseases such as atherosclerosis, hypertension, diabetes mellitus, disorders of the lower urinary tract and erectile dysfunction, characteristic of elderly and old men, were considered separate diseases. However, more and more data have appeared recently, indicating that these and other age-related diseases are closely interrelated and, as a rule, accompany a decrease in testosterone levels in an aging body. This indicates the need for an integrated approach to the treatment of diseases in older men and the inclusion of an analysis of the level of testosterone in blood plasma in the corresponding diagnostic protocols.
Comparison of age-related and classical hypogonadism
Symptoms of hypogonadism include erectile dysfunction, abdominal fat accumulation, mood swings, and decreased muscle and bone strength. Usually, hormone replacement therapy has pronounced positive effects on the condition of young patients with this disease. Comparison of data on similar symptoms developing in elderly men, as well as on a statistically proven decrease in testosterone levels in old age led to the emergence of the terms "age-related hypogonadism" and "age-related androgen deficiency" and the assumption that normalization of testosterone levels in the bloodstream can slow the aging of the male body ... However, to date, there is no reliable evidence that the symptoms described above are actually manifestations of testosterone deficiency. Unfortunately, the data currently available regarding the positive effects of testosterone replacement therapy on the health of aging men cannot be considered scientifically proven. The reason for this lies in the imperfection of research methods, as a result of which they are obtained. Research of this kind should be done in double-blind, placebo-controlled studies. In addition, to assess the results, it is necessary to use not the data on the dynamics of surrogate markers of a particular disease, but the final clinical outcomes. For example, is the risk of diabetes and cardiovascular disease reduced in patients who have had an improvement in metabolic syndrome symptoms as a result of testosterone administration? Or - does the increased bone mineral density as a result of hormone therapy reduce the risk of fractures?
What does testosterone deficiency mean in old age?
In a large number of healthy men, testosterone levels in the blood are 5-20% lower than the accepted normal values, so it is very difficult to draw a clear line between hypogonadal and normal body status. Moreover, the threshold level of the hormone at which a man begins to show symptoms of hypogonadism is very individual and ranges from extremely low values to values that exceed the lower limit of normal values for young men. The factors determining this symptomatic threshold are unknown, however, it is possible that an important role in this mechanism is played by the genetic polymorphism of the androgen receptor, which causes variations in tissue sensitivity to testosterone. The effect of aging and acquired chronic diseases on testosterone threshold levels is not yet fully understood. At the same time, the results of most population studies indicate that obesity, various comorbidities and lifestyle have a pronounced effect on testosterone levels.
Thresholds and dose-dependence of androgenic effects
Empirical evidence supporting the concept of threshold values for testosterone in the development of symptoms of hypogonadism has begun to emerge quite recently. In addition, studies in older men have shown that different levels of the hormone circulating in the blood correspond to different symptoms of testosterone deficiency. So, according to one of the studies, the decrease in libido and muscle strength associated with the level of testosterone was most pronounced with a decrease in the level of the hormone below 15 nmol / L, and the development of depression and type 2 diabetes mellitus - with its concentration in the blood below 10 nmol / L. The authors of this study divided patients into three groups according to their symptoms of testosterone deficiency: psychosomatic complaints, signs of metabolic syndrome and sexual problems. Since the patients of these groups differed in a number of indicators (testosterone content in the blood, age and body mass index), the observed symptoms could not be unambiguously associated with the hormonal background. The situation is further complicated by the multifactorial nature of the disorders observed with a decrease in testosterone levels. For example, the cause of erectile dysfunction, in addition to hypogonadism, can be impaired functioning of the arterial endothelium and the nervous system, as well as psychological and other factors. And given the disagreement about the threshold for the development of symptoms of hypogonadism, the concentration in the blood plasma of total testosterone (according to various sources - from 7.5 to 12 nmol / l), the diagnosis of this disease cannot be made only on the basis of the results of the analysis of hormonal status, without a comprehensive study of somatic and psychological aspects. (Total testosterone includes the free form of the hormone and the complex of the hormone with a carrier protein.)
Diagnostics of the age-related hypogonadism
The decision on the diagnosis of age-related hypogonadism and the appointment of hormone therapy must be made with great caution, taking into account the mutual dynamics of the increase in symptoms and changes in the level of testosterone in the patient's blood. Testosterone is by no means a panacea for all the psychological and somatic problems facing aging men, and its uncontrolled use can have serious negative consequences.
If hypogonadism is suspected, patients should undergo a serious physiological and biochemical examination. In men of any age, periods of transient decrease in testosterone levels are possible, which must be excluded by a detailed study of clinical information and a reassessment of hormonal status. It is necessary to take into account the risk factors for the development of hypogonadism, which include many chronic diseases (including diabetes, chronic obstructive pulmonary disease, inflammatory joint diseases, kidney disease and diseases associated with HIV), obesity, metabolic syndrome and hemochromatosis.
Benefits of Testosterone Replacement Therapy
Restoring testosterone levels to normal levels with replacement therapy can reduce many of the symptoms of hypogonadism in young adults. There is evidence that hormone replacement therapy has a short-term positive effect on the health of older people, including their psychological state, sexual function, body weight, muscle strength, erythropoiesis, bone mineral density, cognitive function and cardiovascular health. systems. Below are the main patterns identified in the study of the effect of hormone replacement therapy on the health of older men.
Metabolic syndrome, type 2 diabetes and cardiovascular disease
Many symptoms of metabolic syndrome (obesity, hypertension, disorders of fat and carbohydrate metabolism, and tissue resistance to insulin) are characteristic of hypogonadism. Low testosterone levels are also associated with surrogate markers of cardiovascular disease and increased mortality from these diseases. According to the research results, the introduction of testosterone to older men improved the indicators of fat and carbohydrate metabolism, which, together with the correction of diet and exercise, led to the normalization of body weight and a decrease in fat deposits in the abdomen.
Low testosterone levels in men are associated with an increased likelihood of developing cardiovascular disease. However, there is no evidence that high levels of the hormone would be consistent with a decrease in this risk. It is possible that the inverse correlation between testosterone levels and the severity of coronary heart disease, identified by scientists, can be explained by the concomitant accumulation of fat in the abdomen, associated with an increased risk of problems in the cardiovascular system and the development of tissue glucose sensitivity disorders and non-insulin dependent diabetes mellitus.
According to the results of studies carried out to date, the introduction of physiological doses of testosterone has a positive or neutral effect on the state of the cardiovascular system of older men. There is evidence of an improvement in the functional state of the vascular endothelium and blood supply to the myocardium, but none of the studies has shown the effect of therapy on the likelihood of developing diseases such as heart attack, stroke and angina pectoris, as well as on mortality rates from them.
Thus, despite the fact that a decrease in testosterone levels is associated with the development of metabolic syndrome and an increased risk of developing cardiovascular diseases, to study the effect of androgen replacement therapy on the incidence of these diseases and the resulting mortality, it is necessary to conduct carefully planned clinical trials of adequate scale and duration.
Bone mineral density
Osteopenia, osteoporosis, and increased bone fragility are common in both young patients with hypogonadism and aging men with normal hormonal levels. With testosterone deficiency, the risk of fractures doubles. However, the role of age-related hypogonadism in increasing the risk of fractures needs detailed study, as well as the long-term effects of testosterone hormone therapy. Testosterone increases the activity of bone-forming cells - osteoblasts and suppresses the activity of osteoclasts performing the opposite function. There is evidence that its administration in sufficient doses increases bone density (but does not ensure the achievement of normal values) in men of all ages with hypogonadism. However, in general, studies on the effect of testosterone replacement therapy have yielded conflicting results, which can be explained by insufficient sample sizes and duration of observations.
Muscle mass and strength
The aging process is accompanied by significant changes in body composition, characterized by an increase in the amount of adipose tissue and its redistribution. This can lead to physical disability and increased mortality. Maximum muscle strength is proportional to muscle mass regardless of age. Testosterone not only directly stimulates protein synthesis and muscle cell growth, but also increases the expression of the similarly acting insulin-like growth factor-1 (IGF-1). Therefore, age-associated decline in testosterone levels may be one of the factors contributing to a decrease in muscle mass and, accordingly, physical strength.
Most of the studies to date indicate that testosterone supplementation generally has a positive effect on the health of older men: it reduces body fat, increases muscle mass, increases the strength of various muscle groups, and generally improves physical performance. Only a small amount of data indicates the absence of the effect of testosterone replacement therapy on the functional state of the muscles. Despite the fact that the introduction of testosterone is considered a promising approach to combat age-related physical weakness, at the present stage it is still not possible to speak unequivocally about the positive effect of such treatment on the physical condition of older men with a deficiency of this hormone.
Increased sex drive, sexual function and performance
The likelihood of developing erectile dysfunction increases significantly with age. Older men require higher testosterone levels than younger men to maintain libido and maintain normal erections. However, erectile dysfunction and / or decreased sex drive, both with normal and low testosterone levels, can be caused by other comorbidities or medications.
The administration of adequate doses of testosterone can prevent premature blood flow from the corpus cavernosum of the penis, which is a common cause of erectile dysfunction in old age. According to a review of evidence from randomized clinical trials, testosterone replacement therapy has a positive effect on the sexual health of older men with testosterone deficiency. The positive effects include not only increased self-esteem and sex drive, but also the frequency of intercourse and erections that occur during sleep.
Condition of the urinary tract
In addition to improving sexual function, testosterone therapy has a positive effect on the functional state of the lower urinary tract in men with age-related hypogonadism, which is manifested by an increase in the capacity and elasticity of the bladder wall and a decrease in the pressure of its sphincter with maximum urine flow.
Mood, energy and quality of life
Men over 50 years of age with reduced levels of free testosterone in their blood often complain of a deterioration in their quality of life, which usually manifests itself with symptoms that overlap with those of major depression, including decreased sex drive, increased anxiety, fatigue, and irritability. When examining the effect of testosterone replacement therapy on the severity of these symptoms, different groups of researchers obtained differing results, ranging from a significant improvement in the quality of life to the absence of any recorded changes. The reason for this may be genetic polymorphism of androgen receptors, which determines the population of men susceptible to the development of depression when testosterone levels fall below a certain level.
Cognitive function
An age-related decline in free testosterone levels is a predictor of deterioration in visual and verbal memory. There is also evidence of a strong relationship between testosterone levels and a number of aspects of cognitive function, such as the ability to orientate in space and mathematical calculations. However, there are data that contradict these observations. For example, in men undergoing hormone therapy for treatment of prostate cancer, suppression of endogenous testosterone synthesis and blocking of androgen receptors had a positive effect on verbal memory, but impaired the ability to orientate in space.
All clinical studies to date on the effects of androgen replacement therapy on cognition and memory have involved relatively small patient populations and have been relatively short-lived. The data obtained in this case contradict each other in some aspects, but in general they indicate that hormone therapy in men with hypogonadism, especially in elderly patients, has a positive effect on their cognitive abilities.
Improvement of symptoms of anemia
It is known that endogenous androgens stimulate the formation of red blood cells in the bone marrow, increase the number of reticulocytes and the level of hemoglobin in the blood, while castration has the opposite effect. Testosterone deficiency leads to a decrease in hemoglobin levels by 10-20%, which can be the cause of anemia. Young men with hypogonadism are characterized by a lower content of erythrocytes and hemoglobin in the blood than for healthy individuals of the same age. A similar decrease in these indicators can be observed in healthy older men.
The safety of giving testosterone to older men
To obtain reliable information about the effect of testosterone replacement therapy on the health of elderly men with hypogonadism, it is necessary to conduct clinical studies with the participation of 5-7 thousand men, which should be monitored for at least 5-7 years. Carrying out work of this scale is quite problematic, so today, to assess the safety of androgen replacement therapy, one has to be content with the results of smaller studies. The main side effects of testosterone administration are described below.
Polycythemia
(a chronic disease of the blood system, characterized by an increase in the absolute number of erythrocytes, and in some cases also leukocytes and platelets).
In men not receiving testosterone therapy, there is a non-linear relationship between testosterone levels and plasma hemoglobin concentration. Testosterone affects erythropoiesis through several mechanisms. It activates the synthesis of erythropoietin in the kidneys, and also directly stimulates the formation of colonies of erythrocyte progenitor cells in the bone marrow. The results of a number of studies indicate that the increase in the values of hemoglobin and hematocrit (volume percent of erythrocytes relative to whole blood) is dose-dependent even when testosterone is administered. In addition, this effect is more pronounced when treating elderly patients.
Elevated hematocrit is associated with a high risk of stroke and coronary heart disease. However, a large-scale meta-analysis of placebo-controlled clinical trials in which testosterone was administered to elderly patients did not generally find an association between hormone-induced hematocrit increases and the likelihood of stroke and other cardiovascular diseases. Thus, polycythemia is a controlled side effect of testosterone administration, provided that hemoglobin and hematocrit are monitored and an adequate dosage of the hormone is selected.
The functional state of the lower urinary tract and prostate disease
In the framework of several studies, when monitoring the condition of men receiving hormone replacement therapy, there were no cases of difficulty urinating due to benign prostatic hyperplasia. Moreover, the incidence of complications such as urinary retention in the experimental groups was the same as in the control groups.
Despite the inconsistency of the data from individual studies, a meta-analysis of the results of studies on the possible effect of testosterone administration on the likelihood of developing prostate cancer also showed that there was no pronounced relationship. However, according to its results, men undergoing hormone therapy are more likely to undergo prostate biopsies. The same applies to the safety of testosterone administration to older men with no history of prostate cancer. At the same time, there are at least three publications, according to which, in 17 patients (in total in all studies), who had previously been cured of prostate carcinoma, the administration of testosterone did not cause tumor recurrence.
Today, it is believed that giving testosterone to older men is a reasonable practice, provided that existing guidelines are followed. This consensus is based on expert opinion, who, however, underscore the need for long-term studies of the safety of therapy.
Diseases of the cardiovascular system
A decade ago, experts were of the opinion that androgens are atherogenic, so it was believed that the introduction of testosterone could increase the risk of developing cardiovascular diseases. Several studies over the past decade have provided evidence that testosterone is not the cause of circulatory system disorders. However, recent epidemiological studies have shown that low testosterone is a predictor of mortality, and numerous reviews that have emerged over the past two years describe a significant relationship between low testosterone concentrations and the likelihood of cardiovascular disease.
The study of the results of testosterone replacement therapy did not reveal the development of such side effects as peripheral edema, exacerbation of hypertension and congestive heart failure. However, given that the existing data are obtained mainly from the observation of relatively healthy elderly men, when treating patients with chronic diseases and generally sick individuals, it is necessary to take into account the possibility of fluid retention in the body.
Sudden cessation of breathing during sleep (apnea)
Obstructive sleep apnea syndrome is characterized by snoring and repeated episodes of closure of the upper airway, leading to decreased blood oxygen levels, sleep fragmentation, and increased daytime sleepiness. This condition is characterized by decreased libido and (in 10-60% of cases) erectile dysfunction. In addition, it is associated with an increased risk of hypertension, arrhythmias, myocardial infarction, stroke, and sudden death. It is not uncommon for patients with sleep apnea to have obesity and metabolic syndrome, which can underlie sexual problems.
Typically, men with sleep apnea have decreased plasma testosterone levels, but this can be attributed to obesity and metabolic syndrome. A large meta-analysis of placebo-controlled trials of hormone therapy in older men found no significant difference between the incidence of sleep apnea in the treatment and control groups. However, obstructive pulmonary disease in obese men or heavy smokers should be considered a relative contraindication to hormone therapy.
conclusions
To date, there have been many studies showing that hormone replacement therapy reduces the symptoms of metabolic syndrome and increases bone mineral density, mood, and sexual function in older men with reduced testosterone levels. However, only a few of these studies have been carried out according to generally accepted scientific standards. In addition, the comparison of the results of these studies is hampered by the lack of generally accepted normal indicators of the hormone level used to diagnose hypogonadism. Another obstacle to an adequate interpretation of the results is the pronounced genetic polymorphism of androgen receptors, due to which the same testosterone levels can form completely different hormonal statuses in different men.
There is strong evidence that testosterone is not a major determinant of prostate cancer in older men. Therefore, subject to the protocols developed by specialists, the administration of testosterone to patients with age-related hypogonadism is quite safe.
Injection forms better for hormone replacement therapy in men. Famous representatives - Sustanon , Omnadren , medicines based on testosterone cypionate and enanthate. After injection, the maximum concentration is reached after 48-72 hours, after which it gradually drops, and after 2 weeks it reaches a minimum.
note
When treating with injectable forms, the effect of a "roller coaster" is described: after administration on the second day, mood, endurance, libido increase, then the effect of the drug is leveled, and the next dose is required. The negative aspects include a supra-physiological effect when the concentration of hormones exceeds the required threshold.
Changing the patient's well-being under the influence of injections is one of the side effects of testosterone injections.
The low cost and relative availability allows, despite the undesirable effects, the use of these drugs today.
Nebido (testosterone undecanoate) is the most highly effective prolonged drug in this group. The frequency of administration is 1 injection every 2.5-3 months. Andrologists and endocrinologists love Nebido for the absence of hormonal surges (it does not have a peak in the concentration increase), ease of use, a full range of actions and minimization of the negative effect on the liver.
Transdermal forms appeared on the market relatively recently, they provide physiological "smooth" testosterone levels. Many patients who previously experienced problems with testosterone enanthate received an effective substitute for pharmacological properties.
The disadvantages include not very convenient application. So, plaster Testoderm attached to the scrotum, and Androderm , which is attached to the skin, in addition to the active ingredient, contains auxiliary substances that, with prolonged use, cause irritation.
Certain application problems are created by the following aspects:
- water procedures can be taken only after 6 hours;
- skin diseases prevent the use of transdermal drugs;
- a hot climate and the associated increased sweating reduce the effectiveness of the action. In addition, there is a risk of transferring the active substance through tactile contact to the partner.
Indications for hormone replacement therapy in men
Hormone replacement therapy is justified in the following conditions:
- primary and secondary;
- 2-sided with confirmed androgenic insufficiency and after the exclusion of malignant neoplasms;
- , and, due to a lack of androgens;
- condition after traumatic removal of the testicles.
Contraindications
- hypersensitivity to the components of the drug;
- breast cancer;
- confirmed or suspected prostate cancer;
- , or ;
- with symptoms of lower urinary tract obstruction.
Relative:
- chronic nicotine intoxication;
- obstructive pulmonary disease;
- polycythemia;
- benign.
note
Do not use testosterone cypionate interchangeably with testosterone propionate.
Side effects of hormone replacement therapy
Taking hormones at your own discretion and without examination is strongly discouraged.
The list of side effects is impressive:
- changes in mental reactions: irritability, aggressive behavior, amnesia,;
- anaphylaxis;
- dysuric disorders;
- engorgement of the mammary glands, gynecomastia;
- hot flashes;
- increase;
- itchy skin and rashes;
- fluid retention;
- thromboembolism;
- increased blood pressure;
- a decrease in the size of their own testicles against the background of atrophy;
- progression of benign prostatic hyperplasia.
Androgen deficiency in older men
The syndrome of age-related androgen deficiency in men is a combination of clinical manifestations with impaired biochemical parameters, which is caused by age-related changes against the background of a decrease in testosterone levels.
It is known that 98% of testosterone in the body is associated with proteins, while free testosterone accounts for only 2%. Testosterone is not highly active and is considered a prohormone (precursor). For the transition to the active form (dehydrotestosterone), the enzyme 5-alpha-reductase is needed.
note
A study conducted in Massachusetts showed that testosterone levels are not stable throughout life and begin to decrease by 2-3% per year from the fourth decade of life, and after 50 - by 0.8-1.6%.
Androgen deficiency is manifested clinically by a combination of symptoms:
- decreased sex drive;
- violation of erectile function;
- drowsiness;
- decrease in bone density;
- loss of pubic hair;
- decreased ability;
- mood swings.
The symptoms themselves are not indicative for the final diagnosis of androgen deficiency; final conclusions can be made after the results of the examination.
The two main groups for hormone replacement therapy in men are exogenous androgens and drugs that stimulate the production of their own testosterone.
Relatively recently, to combat hypoandrogenism, the question of the use of chorionic gonadotropin, which affects the hypothalamic-pituitary system and, indirectly, Leydig cells that synthesize testosterone, is being considered.
Since there is not enough information about the effect of hCG on the male body and side effects, chorionic gonadotropin is not used to correct age-related hormonal deficiency. An exception is when an older man is planning parenthood.
Chorionic gonadotropin treatment does not worsen.
The danger of self-medication
Cardiovascular side effects
The most common cardiovascular negative effects of non-steroidal sex hormones include:
- increased heart rate;
- increase;
- violation of lipid metabolism: a decrease in high-density lipoproteins (HDL) and an increased level of low-density lipoproteins (LDL);
- ventricular.
Liver side effects
All anabolic steroids have a hepatotoxic effect to one degree or another.
The higher the dose of hormones, the more likely an increase in ALT / AST and.
The use of hormonal drugs also leads to the suppression of II, V, VII and X and an increase in prothrombin time. Another life-threatening adverse effect on the part of the liver is peliosis, which is characterized by the appearance of blood-filled, cystic structures. These cysts can be complicated by bleeding, and drug withdrawal usually leads to recovery.
Anabolic steroids are considered risk factors for non-alcoholic fatty liver disease.
Other hepatic adverse effects associated with androgen abuse include subcellular changes in hepatocytes, hepatocellular hyperplasia, and total liver damage.
Endocrine side effects
Endogenous testosterone and spermatogenic functions of the testicles are blocked while taking anabolic steroids, since the production of FSH is suppressed.
In addition, the uncontrolled intake of testosterone alters the function of the pancreas and thyroid glands.
Urogenital side effects
The prostate gland is extremely sensitive to androgens, in response to stimulation, it increases in size. The negative dynamics is especially noticeable if initially there is BPH. Against the background of a violation of the outflow of urine, recurrent, renal hydronephrosis, bleeding and other complications are expected.
Other negative actions include impotence, priapism, etc.
Anabolic steroids in athletes often lead to testicular atrophy and infertility.
Influence on the hematopoietic system
A decrease in the production of direct blood coagulation factors leads to an increase in prothrombin time. Patients taking anticoagulants and anabolic steroids are at risk of bleeding.
Skin side effects
The hairy part of the scalp is rich in many receptors that are sensitive to testosterone preparations. - one of the reactions to exogenous testosterone.
In addition, sebum production is impaired, leading to acne.
Nervous system side effects
Research is underway, preliminary evidence of which suggests that hormone abuse leads to neurotoxic damage. Deteriorate, visual memory weakens.
Another study demonstrated that Nandrolone and Methandrostenolone potentially increase the risk and progression of neurodegenerative diseases.
Anabolic steroids alter behavior, typically:
- mood swings;
- aggressiveness;
- anxiety;
- violation of libido.
What to look for when treating with hormones
Given the many serious side effects, it is necessary to monitor the functions of organs and systems:
You may need to consult an endocrinologist, hematologist, urologist, oncologist, therapist, neurologist, etc.
Hormone replacement therapy is a way to maintain hormone levels at their natural level through exogenous intervention, which is necessary if endogenous hormone production is reduced. Hormone replacement therapy is used, as a rule, at the age of 40-45 years and older, since it is at this age that the natural production of all hormones decreases. It goes without saying that the natural level of each person is individual, therefore, it is recommended to pass tests at the age of 30-35, so that in the future you can rely on this figure, and not proceed from general criteria. The bottom line is that reference values have a range, so for one person the upper value of the reference range may be the norm, and for another the lower value. It is not worth raising the level to the upper value for everyone, because this will disrupt the body's homeostasis, and HRT is a health-improving procedure, and not a way to achieve sports results.
Hormone replacement therapy should be taken under the supervision of a doctor, since this procedure requires permanent monitoring of the state of the endocrine system of the body, the work of internal organs and cancer. Unfortunately, there are not so many specialists who can provide competent assistance in this matter, and those who do are very expensive, so the way out is self-education in the field of medicine, and in particular endocrinology. This article, of course, will not reveal even the thousandth part of the question, since this, firstly, is impossible, here it is necessary to write a textbook and not one, but, secondly, the author does not pursue such a goal. The purpose of the article is to familiarize the reader with this topic, identify the main pros, cons, possible risks and directions in which to dig if the reader is interested in this type of treatment. In addition, the article will provide recommendations on lifestyle regulation and safe self-medication for those who are forced to sound the alarm by test data.
Pros of hormone replacement therapy
1) Increased libido, both in men and women, however, hormone replacement therapy itself differs depending on gender, but the general surge of strength, depression suppression, in general, everything that is called an improvement in the quality of life - this can all be provided by HRT. both men and women. In addition, cognitive functions, which include memory, speed of thinking, etc., improve, which allows you to lead a full-fledged professional life, which also helps to slow down aging, and slowing down aging, not just symptoms, but aging is the main goal and ability of hormone replacement therapy. ...
2) Prevents a number of diseases: osteoporosis, atherosclerosis, regulates lipid metabolism, which prevents the development of diabetes mellitus and "mirror disease" in men, increases immunity, reduces the likelihood of a heart attack by normalizing the ratio of testosterone and estrogen. It is worth noting that testosterone injections or drugs that increase its endogenous secretion also inhibit the secretion of cortisol, which, in general, is the main hormone of "aging", if we consider this process as the predominance of catabolism over anabolism of protein structures.
Indications and contraindications
Indications
to the use of hormone replacement therapy can be: an underestimated level of free testosterone or total testosterone, or an overestimated level of estradiol. All other indicators, whether luteinizing or follicle-stimulating hormones, or globulin indicators, are checked after violations in the ratio of testosterone and estradiol have been identified, therefore the main indication is the level of free testosterone. But, it is important to understand that the goal is not the anabolism of contractile proteins, therefore, it is impossible to underestimate the values of estradiol. Moreover, too low estrogen levels will negatively affect the human condition, especially when it comes to women. For women, in general, it is important to monitor both androgen levels and estrogen levels.
Contraindications: prostate or ovarian cancer, breast cancer, or liver disease, and venous thromboembolism. If a person is diagnosed with cancer, then testosterone or growth hormone cannot be recommended for him, since both of these hormones stimulate the division of cancer cells. Testosterone affects the development of prostate, ovarian and breast cancers, and growth hormone affects any type of cancer. In this case, on the contrary, it is recommended to take drugs that prevent the conversion of testosterone into dihydrotestosterone, which slows down the development of the disease. With liver diseases, excess hormonal load will create excessive stress, therefore, you first need to cure the liver, and only then think about hormone replacement therapy. As for heart diseases, recent studies show that testosterone, on the contrary, has a beneficial effect on the cardiovascular system, but the presence of diseases can still be a contraindication, although not unambiguous.
Analyzes and compatible lifestyle
It is necessary to pass: general blood count and its chemical profile; analysis for total testosterone and its free form, as well as dihydrotestosterone; get tested for estradiol and progesterone; prostate specific antigen for men and for the presence of a predisposition to breast cancer for women; homocysteine and luteinizing hormone. But the main and primary are blood tests and tests of testosterone and estradiol.
Table # 1 Optimal Reference Values for Men 20-49 Years
| A source | LabCorp | SmithKline | Quest Laboratories |
| Total testosterone | 600-1000 ng / dL | 500-833 ng / dl | 500-1000 ng / dl |
| Free testosterone | 26-40 pg / ml | 128-194 pg / ml | 138-210 pg / ml |
| Estradiol | 15-30 pg / ml | 15-30 pg / ml | 15-30 pg / ml |
Table 2 Optimal reference values for women aged 20-49
Low Free Testosterone Levels: at normal values of total testosterone and estradiol, the reason may be the binding of testosterone to globulin - it is necessary to pass an analysis for globulin. If tests show high globulin, aromatase inhibitors and / or antiestrogens are needed.
Low testosterone levels: can be caused by an excess of aromatase, as a result of which testosterone is converted to estradiol, and this process can also be caused by liver dysfunction; low levels of luteinizing hormone; if aromatase, liver and luteinizing hormone are normal, then most likely the problem is in the testicles, and an exogenous analogue of testosterone must be injected, if the problem is with luteinizing hormone, treatment can be carried out with hCG, and for women aromatase inhibitors or antiestrogens.
High estradiol levels: in this case, it is necessary to take antiestrogens and / or aromatase inhibitors; from self-medication Consider supplementing zinc, magnesium and vitamin D, reducing alcohol consumption to the point of complete withdrawal, lowering subcutaneous fat levels, and reviewing other medications that may suppress testosterone secretion or promote aromatization. In general, these recommendations are relevant for the cases listed above.
Sources:
Fatieva I.Yu. "Human Anatomy. How Your Body Works"
Terney A. L. "Modern organic chemistry"
Testosterone is produced by the testes in a percentage of more than 90%, the rest of the insignificant amount is produced by the adrenal glands. It is possible to disrupt the flow of androgen into the blood under the influence of external and internal factors.
Conditions for lowering testosterone:
Drinking beer containing phytoestrogen, as well as smoking, poisoning the body, has a negative effect. With prolonged exposure to testosterone deficiency syndrome, it is possible to reduce the vegetation on the body and change the timbre of the voice.
FACT... Irregular sex life suppresses sexual reflexes - testosterone in the blood decreases.
What to do in such a situation? Medicines or folk remedies?
Herbs and other natural ingredients are used if testosterone decreases for a short period of time. The hormonal background is most easily corrected after the elimination of destabilizing factors, especially alcohol abuse, the effects of nervous tension and malnutrition.
However, there are prerequisites for the need for drug treatment if significant physiological disorders are diagnosed.
Rationality of therapy for:
- mechanical damage to the genitals;
- genetic diseases;
- pituitary tumors;
- orchitis and cryptorchidism;
- varicocele, spermatocele and hydrocele.
Infectious inflammation of the scrotum organs, which often occur when infected with sexually transmitted diseases, are also dangerous. Against the background of emerging damage to the skin, balanoposthitis and epididymitis occur.
When infected with mycoplasmosis and trichomoniasis in men, testosterone levels also decrease simultaneously with a deterioration in spermatogenesis.
Chlamydia provokes inflammation of the appendages, bladder and impaired potency.
The destruction of extraneous pathogens is carried out mainly by taking powerful antibiotics, and only then therapy is carried out to restore the balance of testosterone in the blood.
With diagnosed asthenospermia (the number of motile sperm is less than half of their total number) and azoospermia (active germ cells are completely absent), the help of natural components will no longer be enough.
Congenital forms of a lack of male hormone are called Kallman syndrome and Klinefelter syndrome.... In the latter case, not only testosterone deficiency is observed, but also poorly developed genitals.
Andrologists in such situations prescribe medications that force the return of a healthy hormonal background. In old age, you need to be prepared for the appearance of andropause: after 50 years, a significant decrease in androgen is a natural process that can only be corrected with medication.
WARNING... For men with prostate cancer or other diseases of the prostate gland, an increase in the concentration of testosterone in the blood is contraindicated.
Tactics for treating a lack of testosterone in men: exercises, recommendations, medications
Phytoproducts are used as conservative methods to restore healthy hormone levels. Tinctures of ginseng, eleutherococcus, schisandra chinensis and leaves of the ginkgo tree have a strong tonic effect.
A tangible help is provided by the use of multi-complexes(Vitrum, Alphabet, Multitabs) containing vitamins from which testosterone is built (B, C, E, D), and trace elements (zinc and selenium). Of the products, andrologists advise to “lean” on nuts, ginger, dried fruits, garlic, eggs and seafood.
Physical activity is similarly included in the list of what is called a must-have for androgen deficiency syndrome.
Helpful Exercises to Boost Testosterone Production:
- warm-up (5 to 10 minutes);
- barbell lifting exercises (10 to 40 minutes);
- strength training for large muscles (legs, chest, back);
- abdominal exercises (10–20 min).
Male rivalry is a traditional source of testosterone boosts. Since ancient times, domination has made men feel euphoric after victories in wars or hunting.
In modern conditions, these methods can be viewed as barbaric and unethical by some men, so it is rational to choose more civilized methods of uplifting.
Participation in sports - from running to boxing- can be helpful in treating insufficient androgen levels in the blood using the most natural methods.
Career success is also seen as an element of social dominance that restores a man's natural strength. The peak rise in testosterone is observed during the period of promotion, with active self-development and career achievements.
The production of the hormone occurs in the same way when contemplating the female naked body, therefore, to strengthen the sexual constitution, the number of sexual contacts should be increased.
Less androgen is formed during verbal communication with the opposite sex without erotic contact.
Along with the above recommendations, you should increase physical activity - the best option is to sign up for the gym. Muscle tension automatically activates the male reflex, forcing the production of more testosterone.
If conservative methods are ineffective, then the doctor has the right to prescribe drugs of the androgenic group. Common injection options: Sustanon 250, Nebido, Testosterone propionate, Omnadren. Andriol can be prescribed as tablets, Androgel ointments.
Duration of taking testosterone products:
- ampoules - within 7-10 days;
- tablets are taken up to 1 month;
- gel - 1-3 months.
These drugs inject artificially created testosterone into the bloodstream, but there are also medications that force the reproductive system to reanimate the production of its own hormone.
Medicines of this group: Arimatest, Evo-Test, Vitrix, Tribulus, Animal Test... By suppressing aromatase, a testosterone antagonist, anabolic substances lead to a sharp increase in the male hormone, but their intake is recommended in conjunction with a trip to fitness clubs or sports complexes.
WARNING... Lifelong administration of injections is possible only with congenital insufficient development of the testicles - hypogonadism - or the loss of their functions by the testicles during life.
Conclusion
Treatment of patients with low testosterone is necessary: the long presence of a weak hormonal background leads to obesity, impotence and even premature aging of a man.
Maintaining the production of sufficient androgen concentrations helps to prolong well-being and permanently consolidate the behavioral and physiological qualities that are truly inherent in the stronger sex.
In conclusion, watch a video about drugs for increasing testosterone in men based on tribulus:
